CAJ | 학술논문

目的：评估回收式自体输血对骨科患者血液流变学和免疫功能的影响及相应护理干预的效果。方法选择骨科就诊的患者67例，分为异体输血组（A 组）和自体输血组（B 组），分别为31例和36例。 A 组采用异体输血并常规护理，B 组采用回收式自体输血加用预见性护理。输血前及输血后分别检查两组患者的血液流变学、免疫功能及护理效果。结果两组输血后红细胞计数、血细胞比容较输血前明显下降，差异有统计学意义（ P ＜0．05）。比较输血后红细胞聚集性、红细胞刚性，两组输血后与输血前差异均无统计学意义（P＞0．05），但 B 组红细胞聚集性较 A 组表现出下降趋势。 A 组异体输血后 CD4＋、CD4＋/CD8＋、NK 细胞较术前明显下降，差异有统计学意义（P＜0．05），CD8＋较输血前明显增加，差异有统计学意义（P ＜0．05）。 B 组输血后与输血前无明显变化，差异无统计学意义（P＞0．05）。比较两组输血后免疫功能变化，B 组 CD4＋、CD4＋/CD8＋、NK 细胞较 A 组明显增高（P＜0．05），CD8＋明显下降，差异有统计学意义（P＜0．05）。 B 组采用循证护理及预见性护理后，术后并发症发生率明显降低，两组发生率差异有统计学意义（P＜0．05）。结论回收式自体输血可维持血液流变学的稳定并维持正常免疫功能，配合预见性护理可减少并发症的发生。
목적：평고회수식자체수혈대골과환자혈액류변학화면역공능적영향급상응호리간예적효과。방법선택골과취진적환자67례，분위이체수혈조（A 조）화자체수혈조（B 조），분별위31례화36례。 A 조채용이체수혈병상규호리，B 조채용회수식자체수혈가용예견성호리。수혈전급수혈후분별검사량조환자적혈액류변학、면역공능급호리효과。결과량조수혈후홍세포계수、혈세포비용교수혈전명현하강，차이유통계학의의（ P ＜0．05）。비교수혈후홍세포취집성、홍세포강성，량조수혈후여수혈전차이균무통계학의의（P＞0．05），단 B 조홍세포취집성교 A 조표현출하강추세。 A 조이체수혈후 CD4＋、CD4＋/CD8＋、NK 세포교술전명현하강，차이유통계학의의（P＜0．05），CD8＋교수혈전명현증가，차이유통계학의의（P ＜0．05）。 B 조수혈후여수혈전무명현변화，차이무통계학의의（P＞0．05）。비교량조수혈후면역공능변화，B 조 CD4＋、CD4＋/CD8＋、NK 세포교 A 조명현증고（P＜0．05），CD8＋명현하강，차이유통계학의의（P＜0．05）。 B 조채용순증호리급예견성호리후，술후병발증발생솔명현강저，량조발생솔차이유통계학의의（P＜0．05）。결론회수식자체수혈가유지혈액류변학적은정병유지정상면역공능，배합예견성호리가감소병발증적발생。
Objective To evaluate the influence of salvaged autotransfusion on hemorrheology and immune function in orthopedic patients and the effects of corresponding nursing intervention .Methods 67 orthopedic patients in our hospital were selectred and divided into the allogeneic transfusion group (group A ,31 cases) and the salvaged autotransfusion group(group B ,36 cases) .The group A adopted the allogeneic blood transfusion and routine care , while the group B accepted the salvaged autologous blood transfusion plus predictive care .The hemorrheology ,im-mune function and nursing effects in the two groups were checked before transfusion and after transfusion .Results Red blood cell(RBC ) count and hematocrit after blood transfusion in the two groups were significantly decreased compared with before transfusion (P< 0 .05) .RBC aggregation and erythrocyte rigidity in the two groups had no sta-tistical difference between before and after blood transfusion (P > 0 .05) ,but the erythrocyte rigidity in the group B showed the decreasing trend compared with the group A .CD4 + ,CD4 + /CD8 + and NK cells after allogeneic blood transfusion in the group A were significantly decreased than before transfusion (P< 0 .05) ,CD8 + was significantly in-creased than before transfusion(P< 0 .05) .The group B had no obvious change between before and after transfurion (P> 0 .05) .Comparing the changes of the immune function in the two groups ,CD4 + ,CD4 + / CD8 + and NK cells in the group B were significantly increased than the group A (P < 0 .05) ,while CD8 + was significantly decreased(P<0 .05) .After adopting the evidence-based nursing and the predictive nursing in the group B ,the occurrence rate of complications was significantly decreased ,the difference between the two groups had statistical significnce ( P <0 .05) .Conclusion The salvaged autotransfusion can maintain the hemorrheological stability and normal immune function ,which cooperated by the predictive nursing can reduce the complication occurrence .